ET Tube suction.

nurse4sale · Jan 21, 2013

Hello. I'm really new to neonates and I'm loving it so far. My main concern is I'm underconfident when it comes to suctioning a Et tube.
I know how to do it, but I struggle with when to do it, if I should use saline, how many times I should do go down etc. I ask for help every time I need to suction a baby but our unit is really busy and at times no one is available. I'm also aware that the more I ask for help, the more I'm finding myself never wanting to do it on my own.
Does anyone know of any resources online that are helpful in this topic?

I know how you feel. My fear was putting NG tubes in patients. I always grabbed one of my colleagues to come help me. My colleague would do everything while I handed her what she needed. I knew how to do it, I just didn't have the confidence to do it, until one day. I was sent to another floor where I didn't know anyone and came face to face with an order to put in a NG tube for Gastrointestinal decompression. I had to do it and once I did it, I was fine, confidence surrounded me. My patient didn't even vomit once. When you're good, you're good. Please muscle up the courage to do it. Don't get stuck like me, when you're on a floor with no familiar faces there to help. Now I volunteer when ever there is a NG tube placement, I go and do it. That's the only way to conquer your fear, is to just do it.

Luckyyou, BSN, RN · Jan 22, 2013

Are you using in-line catheters?

K+MgSO4, BSN · Jan 22, 2013

do you have an educator that can run you through the process..............tell her that you are not 100% confident and want a refresher or ask her to assess your technique

Sun*shine · Jan 22, 2013

Thanks for your replies :) Nurse4sale that's reassuring to know, if anyone offers to do it for me I leap for joy and let them. Not good for me in the long term. And I feel embarrassed asking for help now because I don't want anyone to think I'm incompetent. Well done for getting over your fear. K+MgSO4 yes we have a clinical educator and I think I'll have a chat with her about it. She’s not based at our hospital and it’s rare that we see her so I guess that’s why I’ve not gone to her yet. But she’s brilliant and I’m sure she’d make a point of coming to see me though if I asked for help. Cerriwin we don't use in line catheters, so it's quite 'fiddily' in my opinion. I think it adds to the pressure when you're having to take the vent off. I really could be done with a third hand.

NicuGal, MSN, RN · Jan 23, 2013

We only use in lines where we are with the occasional kid needing 2 man suction. You shouldn't be using saline either unless there are very thick secretions, you damage cilia and was colonized bugs down the tube and into the lungs. This is all EBP. I'd ask for help, you don't want to extubate a kiddo. And you are right, you shouldn't be taking them off the vent to suction, you lose pressures.

Guest343211 · Jan 23, 2013

I prefer nebulizer nss, if needed, better than the straight-up nss squirt.

MiniBabyRN · Jan 24, 2013

Do you have respiratory therapists on your unit? They are a great resource too (If they're willing to teach!). We only use in-line suction, It definitely makes suctioning less intimidating!

Sun*shine · Jan 25, 2013

I wish we had in-line suction. We don't have chest physios based on the unit, they'll only come if there is a real concern about an infant's respiratory state. Physios don't see ventilated babies as routine. Now I think about it I find this odd, because chest physios would see everyone in an adult icu. Thanks for explaining the saline part :up: I know now not to use it every time.

dah doh, BSN, RN · Jan 26, 2013

Ask for help, but make sure you do the actual suctioning and they are more of the observer. As you you do it more, you will gain confidence in you ability to do it yourself. Saline lavages are discouraged except for thick secretions or to clean the Ballard. And why don't you have in lines?

imaginations · Jan 26, 2013

you shouldn't be taking them off the vent to suction, you lose pressures.

It's actually not the disconnection from the vent that causes loss of pressure/derecruitment. That is a result of suctioning itself (i.e. because you're occluding the airway -- the ETT -- with the suction catheter for the purpose of suction.)

In my unit we use a suction port on the ETT/vent circuit connection. So, we don't use in-line, but we don't have to disconnect. However we find the process is often fiddly and difficult because passing a catheter through the one way valve of the suction port is difficult and you don't tend to get as many secretions as you do when you disconnect the vent and suction.

A number of nurses on my unit recently went to a high frequency ventilation conference and attended a seminar purely on suctioning whilst kiddo is on the vent. Numerous things that they heard in this seminar were applicable to conventional ventilation. They were shown two images of lungs following suction and asked to chose which patient had been disconnected during suction and which had not. Everyone chose the worse looking, more de-recuited pair of lungs as being disconnected for suction. In fact, the opposite was true.

Suction itself causes de-recruitment, not disconnection.

RainDreamer, BSN, RN · Jan 26, 2013

Ask for help if you don't feel comfortable. I agree with another poster that said ask for help, but YOU do the do the suctioning ..... the other person will be there for assistance and answering any questions you have. Don't feel embarrassed asking for help. Before long you'll be the one others will be coming to with questions ...... just give it time :)

Is it typical for units not to use inline suction? We use two man suction on the jets, but that's it.